Gianna is an associate editor of The American Journal of Managed Care® (AJMC®). She has been working on AJMC® since 2019 and has a BA in philosophy and journalism & professional writing from The College of New Jersey.
The intersection of climate change and negative impacts on health were brought into sharp focus this week with executive orders from President Biden, a move by General Motors (GM) to stop making some gasoline-powered cars, and top global cardiology organizations calling for urgent action on air pollution.
In the span of less than 1 week, President Biden, General Motors, and international health organizations all announced renewed focus on the intersection of climate change and health.
During his first full week in the White House, President Joe Biden signed executive orders announcing sweeping reforms to the previous administration’s climate policies, including re-joining the Paris climate accord, cancelling the Keystone XL pipeline, and pausing oil and gas leasing on federal land, while Wednesday, he added an office devoted to climate and health to HHS.
On Thursday, 4 leading cardiovascular organizations—the World Heart Federation (WHF), American College of Cardiology (ACC), American Heart Association (AHA), and European Society of Cardiology (ESC)—issued a statement urging the medical community and health authorities to work to mitigate the effects of air pollution on people’s health.
And, in a historic move, General Motors announced Thursday it will end the sale of all gasoline and diesel powered passenger cars and sports utility vehicles by 2035.
“General Motors is joining governments and companies around the globe working to establish a safer, greener and better world,” said Mary Barra, the chairman and CEO, in a statement. “We encourage others to follow suit and make a significant impact on our industry and on the economy as a whole.”
Leading health organizations have been sounding the alarm for years over the detrimental impacts unchecked climate change will have on global health. While it remains to be seen whether Republican lawmakers will accede to future long-term legislative reform or respond to changes initiated by the business community, concerns regarding job losses in the oil, coal, and gas sectors have largely inhibited swift transitions to renewable, clean energy sources.
But in recent years, air pollution alone has been linked to serious adverse pregnancy outcomes, increased risks of diabetes, obesity, Parkinson disease, Alzheimer disease, multiple sclerosis, dementias, and cardiovascular disease, among other conditions. More often than not, poor individuals bear the brunt of pollution-related adverse health outcomes.
In 2020, research also found even “a small increase in long-term exposure to particulate matter (PM2.5) leads to a large increase in coronavirus disease 2019 (COVID-19) death rate, with the magnitude of increase 20 times that observed for PM2.5 and all-cause mortality.” In the United States, racial and ethnic minorities and lower-income individuals have disproportionately suffered from the pandemic.
Not only does a changing climate result in poor health outcomes, but inaction could lead to debilitating economic ramifications. A 2019 GeoHealth analysis concluded that in 2012, US wildfires, extreme heat and weather, infectious disease outbreaks of tick-borne Lyme disease and mosquito-borne West Nile virus, among other climate-related calamities resulted in a total of $10 billion in health related costs, with mortality costs of $8.4 billion—exceeding illness costs and lost wages ($1.6 billion combined).
A 2019 review published in The New England Journal of Medicine also warned that unless governments act cohesively and urgently, warming temperatures by the year 2100 (79 years from now) will cause increases in illness and death stemming from heat-related illnesses, bad air quality, poor nutrition from reduced food quality and security, an increase in vectorborne diseases, and economic impacts from reduced worker productivity.
Apart from the physical and economic impacts of climate change, increased rates of natural disasters could wreak havoc on individuals’ mental health. According to The Atlantic, data show between 10% and 30% of wildfire survivors develop diagnosable mental-health conditions, including post-traumatic stress disorder (PTSD) and depression. Although another 50% may suffer from serious subclinical effects that fade with time, investigations found rates of substance abuse and domestic violence both increase after natural disasters.
“The stakes on climate change just simply couldn’t be any higher than they are right now. It is existential,” said John Kerry, the newly appointed special presidential envoy for climate at a press briefing Wednesday. “This is an issue where failure literally is not an option.”
In 2019, the American Medical Association backed a movement from doctors, health organizations and students for medical education to include climate change.
Now, citing the triple threat of air pollution, COVID-19, and cardiovascular disease, the ACC, AHF, AMA, and ESC said the consequences on human health can no longer be ignored.
They cited statistics from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, which in 2019 attributed an estimated 6.7 million deaths, or 12% of global deaths, to outdoor or indoor air pollution; as many as half of these were due to cardiovascular disease.
“Even before the COVID-19 pandemic, air pollution was an issue of growing concern due to its impact on people’s health, although it was frequently overlooked as a risk factor for cardiovascular disease,” said statement coauthor and chair of the WHF air pollution expert group, Michael Brauer, PhD, and an affiliate professor at IHME. “COVID-19 has brought a new, deadly factor to the equation, and the time has come for the health community to speak up and take action.”
Both structural changes and health care provider actions can play a role in reducing harmful exposure to air pollutants, the organizations said. By advocating for air pollution mitigation as a health measure, furthering research on air quality, and providing patients with personal measures to reduce exposure—like room air filtration systems—providers can help improve patient outcomes in the short- and long-term.
“Air pollution is one of the most underestimated causes of heart disease and stroke,” said Stephan Achenbach, MD, FSCCT, ESC president. “More research is urgently required to identify susceptible populations and to determine the optimal methods of improving air quality to benefit cardiovascular health. Air pollution needs to be recognized as a major modifiable risk factor in the prevention and management of cardiovascular disease, and measures to reduce its detrimental short-term and long-term influence on cardiovascular health, potentially over generations, are urgently required.”
Highlighting the disproportionate impact poor air quality has on low-income communities, Robert Harrington, MD, FAHA, professor of medicine and chair of the Department of Medicine at Stanford University, stressed, “We must address this problem as a global community to equitably reduce exposure to air pollution and reverse the health harms of poor air quality for all.” Harrington is also the immediate past president of the AHA.
From a public health perspective, air quality (ie, fine particles and ozone) continues to be a major social determinant of health. In a study published in the January 2019 issue of The American Journal of Managed Care® researchers used applied machine learned to predict healthcare utilization based on socioeconomic determinants of care.
Results showed the social determinant of health “most associated with risk was air quality, which had a relative value more twice that of the next determinant, income. Air quality had a relative value more than 30-fold higher than the lowest-weighted determinant, percentage in group living quarters.”
A recent systematic review examining the interrelation between air pollution and pregnancy outcomes found that of 10 studies on the association of racial/ethnic disparities with increased risk of preterm birth among mothers in minority groups, 8 noted higher risk for Black mothers, which was the most consistent finding among the subgroups.
To help address these disparities at the national level, the Biden administration this week created an office of health and climate equity in HHS which will direct the government to spend 40% of its sustainability investments on disadvantaged communities.
“Lifting up these communities makes us all stronger as a nation and increases the health of everybody,” the President said.
However, coal—the single largest emitter of energy-related carbon dioxide emissions—was notably absent from the President’s recent freezing of oil and gas lease sales, as reported by Bloomberg, prompting some clean energy proponents to express disappointment.
“This order should have included all fossil fuel extraction on public lands,” Mitch Jones, the policy director at Food and Water Watch told Bloomberg, noting the decision to leave coal out was ‘scientifically unsound.’ “The fight against climate change demands that we remain vigilant against all fossil fuel extraction,” Jones said.
According to Gina McCarthy, the White House national climate advisor, coal leasing will undergo review as part of a wider analysis of fossil-fuel leasing.